Alexander Technique and Physical Therapy
The Alexander Technique


(made simple)

Homeostasis of fluid circulation:

        Arterial flow = venous flow + lymphatic flow

           in other words…

filtration = resorption

           in other words…

(fluid leaving the vessel & entering the interstitium)
        = (fluid entering the vessel & leaving the intertstitium)

           in other words…

 Fluid leaving the heart = Fluid returning to the heart

The Lymphatics’ serve us in preserving:
                1.) fluid balance
                2.) the body’s defense
                3.) the body’s nutrition

The Interstitium is the empty space under the skin, above the muscles, and between the vessels. Within the interstitium are the blood capillaries and initial lymphatics coming together to begin the journey of the fluids (no longer needed for cell nutrition) back to the heart.

The blood capillaries of the venous system cannot transport the heavier protein cells, dead cells (debris), bacteria, and other waste products. This is the job for the initial lymphatics – to take up these heavier fluids and send them on to the larger collector vessels, on to the nodes (where lymph is filtered and lymphocytes are produced and stored for entrance into the bloodstream to fight antigens and bacteria) and more vessels and more nodes until lymph reaches the deep lymphatic vessels of the cistera chylli and abdominal region, and finally to the Major Lymphatic Ducts (Thoracic duct and Right Lymphatic Duct) that return the lymph fluids to the heart where all fluids are then circulated for oxygenation and pumped back out to the body through the arterial system:
initial lymphatics collector vessels nodes → more vessels and nodes deep lymphatic vessels Major Lymphatic Ducts heart

What mechanism encourages the take-up of lymph by the initial lymphatics, vessels without valve structures to pump? The lymph moves by “force pump”, a sensitivity to change in pressure. Needed changes in pressure occur with:

muscle work (working pressure),
external pressure (resting pressure)
respiration (breathing changes thoracic pressure).

A directional light massage technique called Manual Lymph Drainage is used in treatment of lymphedema to stimulate and direct the flow of lymph fluids. All management techniques learned in therapy are based on these four ways to stimulate lymphatic flow.

The lymphatic System is similar to the roadways of a town. The fluid flow back to the main vessels that lead to the heart is like cars moving along the country roads on their way to the interstate (the nodes and vessels of the axilla [arm pit]). With compromise from surgery and radiation the interstate is closed, traffic jams are forming. The traffic backs up until the byways leading to the main thoroughfare become crowded and jammed. Detours must be found. The job of the physical therapist lymphedema specialist is to help create the detours, to bring the natural lymph flow of the body back into gear, to direct the lymph around the compromised area and over to healthy areas that can function to redirect the “traffic” and unblock the stagnant fluids in the limb. All components of the self-management program (wrapping, compression garments, self-massage, aerobic, stretching, breathing, and strengthening exercises) are designed to encourage lymphatic flow, as well.

Copyright Idelle Packer, 2006

Summary, Breast Cancer Related Lymphedema
Physical Therapy following the Diagnosis of Breast Cancer
Physical Therapy when Postural, Orthopedic, or Neurologic Symptoms occur following Surgery
Physical Therapy at the Onset of Lymphedema
Lymphedema Management
Kinesio Taping for lymphedema
The lymph system helps to maintain the body's fluid balance. The lymph fluid from the arm drains into the axilla ( armpit) and flows
through the axillary lymph nodes. The lymph nodes act as filters to destroy toxins and viruses, for example, and therefore play an
important role in the immune system. Once this system is compromised either through surgery and/or radiation, the arm is
much more prone to infection through even a pin prick or a mosquito bite.

      Linda T. Miller, PT, Recovery in Motion, Breast Cancer Physical Therapy Center, Philadelphia, PA